Submucosal Dissection of Pyloric Neoplasms Is Feasible

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

The complete resection rate was 75% overall but lower for lesions extending into the duodenum, larger lesions, and those located in the upper hemisphere.

Neoplasms occurring in the pylorus are more difficult to remove by endoscopic submucosal dissection (ESD) than lesions that occur in most other areas of the stomach.

Investigators at a single hospital in Korea retrospectively reviewed outcomes of ESD of 110 pyloric adenomas during a 7-year period. The location of the adenomas was documented. The lesions were resected by one of two experienced endoscopists using a standard technique. Clinical, endoscopic, and histologic characteristics of the resected lesions were evaluated. The primary outcome was the rate of successful, complete endoscopic resection. Procedure time, adverse events, and recurrence rates were secondary outcomes.

The en bloc resection rate was 83%, the piecemeal resection rate was 17%, the complete resection rate was 75%, and the recurrence rate was 2%. Eleven procedure-related adverse events occurred, including bleeding (9), perforation (1), and stenosis (1). Complete resection rates were lower in tumors with extension into the duodenum (58% vs. 79%), location in the upper versus lower hemisphere (67% vs. 90%), size >10 mm (67% vs. 84% for ≤10 mm), and circumferential extent of resection >50% (62% vs. 92% for ≤50%).

Citation(s):

Bae JH et al. Factors associated with the outcomes of endoscopic submucosal dissection in pyloric neoplasms. Gastrointest Endosc 2014 Jul 23; [e-pub ahead of print].